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Chapter 3:

Keeping Track

In This Chapter, You’ll Learn:

• How to determine your real life eating habits

• How to use a food diary and blood glucose records

• How to build a personal database of carb counting information

In a perfect world you would eat about the same amount of carbohydrate at the same times, seven days a week. However, for most people this plan just doesn’t mesh with their schedules, and with the medication options available today, people with diabetes have more flexibility in meal planning. Depending on your preferences and your daily routine, you can put together a daily meal plan that works for you.

That’s why it’s important to let your health care providers know as much about your eating style and daily schedule as you can. The best way to accomplish this is to keep records of your current food habits in a food diary. You’ll also need to figure out how much carbohydrate you eat and when on most days. Eating similar amounts of carbohydrate on a fairly regular schedule is the cornerstone of basic carb counting. Keep detailed, and honest, records. It’s the only way you can trust your results and put them to good use in managing blood glucose.

Your records are particularly important if you take blood glucose–lowering medication, and most people with diabetes do. Your diabetes care providers need to know your preferred schedule of meals and snacks and when you usually eat, because all of these factors affect the type of blood glucose–lowering medication they prescribe for you and the way they teach you to take them. Don’t let them prescribe medications for you based on an idealized nine-to-five lifestyle that simply isn’t true to your life. Some medications have different have onset and peak times and durations of action. This “action curve” needs to be in sync with when you eat. (For more information on medications and their effects, see Chapter 10.)

Seven Steps

Take a look at these seven steps to help you get a sense of your eating patterns, figure out how much carbohydrate you currently eat and the types of carbohydrate-containing foods you eat, and compare your food records with your blood glucose records. Take these steps one at a time and you’ll be well on your way with carb counting.

Step 1: Keep Food Records

Begin keeping a food diary by recording the foods you eat at breakfast, lunch, and dinner. Don’t forget to include snacks and nibbles. Yes, crumbs do count! Keep these records for a full week, including the weekend. It’s important to note both the type of food and the amount that you eat. The more accurate you can be, the more helpful your food records will be to you and to your health care provider. It helps to use a food scale and measuring cups and spoons to measure portions accurately, especially as you’re learning. You can design your own food record or use one similar to the record on Table 3-1. Your food records should include the following:

• Day of the week

• Mealtime

• Amounts of food

• Carb grams for each food

• Total carb grams for the meal or snack

Begin by just entering the food you ate for two days.

Step 2: Find the Foods You Ate that Contain Carbohydrate

After you have one week of your food diary completed, go through and circle the foods that contain carbohydrate. You can identify these foods by using the list of foods in Appendix 1 or by using one or more of the resources listed in Appendix 2. See Table 3-2 for an example. As you can see, it’s not just the rice, bread, and desserts; dairy foods and fruits contain carb, and even salad dressing may contain a few grams.

Step 3: Figure How Much Carb You Eat

Now, go back and figure out the number of grams of carbohydrate in each of the foods you ate. Table 3-3 shows an example of how this is done. Then add up the totals for each meal and snack. If you plan to use carb servings rather than grams of carbohydrate, remember that each carb serving contains about 15 grams (g) of carbohydrate.

Step 4: Sit Back and Observe

Now use the information in your food diary to see if you eat about the same amount of carbohydrate for breakfast, lunch, dinner, and snacks each day, and if you eat at the same times each day. In the two days of sample records (above), the carbohydrate in the breakfasts vary from 73 to 97 grams, and the breakfast times are very different, too. One day breakfast is at 7 a.m. and the next it’s at 9 a.m. As you have already learned, varying the amount of carbohydrate and the timing of breakfast this much will make it more difficult to control blood glucose levels. That’s particularly true if you, like most people, take the same amount of medication each day.

Step 5: Get Familiar with the Carb Counts of the Foods You Eat

Most of us are creatures of habit—we eat the same foods day in and day out. That’s good news when it comes to carb counting because this makes it easier to build your own personal “database” of carb counts.

As you start to build your personal database, think about what record-keeping format works for you (a sample is found in Appendix 3). Will it be best to keep your database in your smartphone, or in a small notebook that you carry with you? Or is it better for you to keep it as a continually growing spreadsheet on your computer, with the type of information in Table 3-4: the food, the amount you eat in a serving, and the carb count in grams? You be the judge.

Start to build your carbohydrate database by making a list of the foods you regularly eat at meals. Then determine the carb counts for one serving of each food on the list. When you have a Nutrition Facts label, use the Total Carbohydrate count from the package. If the size of the serving you eat is bigger or smaller, do the math to determine the carb count for the amount you eat. When you don’t have a Nutrition Facts label to work from, such as with fresh fruits and vegetables, look up carb counts in Appendix 1 or in one of many available resources listed in Appendix 2.

Carb counts: From foods to meals

After you have looked up the carb counts of the individual foods you regularly eat, count up the total grams of carbohydrate in meals that you regularly eat. Keep a record of these as well. Again, we are creatures of habit, not only in the foods we choose to eat, but in the way we combine these foods for meals and the amount of food we eat. You can save time in the long run by spending a few minutes developing a database of the carb counts of your common meals.

Step 6: Figure Out How Much Carb You Should Eat

Now you have a picture of how much carbohydrate you usually eat at your meals and snacks. Now you need to determine whether the amount you’re eating is too much, too little, or just about right. As we said before, your target carbohydrate intake will vary based on a variety of factors. Most women need three to four carbohydrate servings (45–60 g) and most men need about four to five carbohydrate servings (60–75 g) at each meal.

Step 7: Match Up What You Eat with Blood Glucose Records

The next step is to match your food records with your blood glucose records. Checking your blood glucose at various times of the day is the best way to learn how your blood glucose responds to food, activity, stress, and other things in your life. But it’s equally important to record the results! If you don’t record the results, the data—and the opportunity to learn from it—are lost.

After-meal blood glucose checks are especially important, particularly as you are learning carb counting. That’s because after-meal (one and a half to two hours after the time you begin eating) blood glucose checks help you see the impact of the carbohydrate you ate on your blood glucose. Obviously, your goal is to have your blood glucose in target ranges both before meals and after as often as possible. Table 1-2 gives you the target ranges of blood glucose, so you can see where yours are in relation to them.

Now don’t be alarmed; you don’t need to check your blood glucose constantly! To observe the ups and downs in your blood glucose, yet avoid feeling like a human pincushion, set up a rotating blood glucose checking pattern. Check your blood glucose two to three times a day at different times on different days. In just a few days, you’ll have results from around the clock. Table 3-5 shows a four-day sample pattern with two checks a day.

You’ll likely need to check your blood glucose levels more often when you start carb counting, until you get a sense of your blood glucose patterns. You might also have to check more if you make a change in the dose of a medication, add a medication, start an exercise program, etc. When your diabetes management plan changes, more frequent blood glucose checks can help you adjust.

Keeping Records for the Long Haul

Following this seven-step plan for a few days helps you get a sense of how carb counting works and how your blood glucose level reacts to the food you eat. Going forward, you’ll want to keep even more detailed records to help you and your diabetes care provider track your progress and make adjustments to your treatment plan. For your long-term record keeping, you’ll want to note more than just your carbohydrate intake and blood glucose levels. The information below introduces other factors you’ll want to track:

Physical Activity

Being physically active generally lowers blood glucose (but be aware that it can also raise blood glucose). Being physically active is an important part of managing your diabetes, and an important part of staying healthy. If you’re not already physically active, it’s always a good idea to start! Any amount of activity is good—but it’s also important to remember to note it in your records. Be sure to write down the type of activity, how long you did it, and when. Be sure to check with your health care team before you start an exercise regimen.

Emotions, Stress, Illness, and Unusual Situations

Changes in day-to-day events can affect blood glucose levels, too. When you or a loved one is ill or when you’re dealing with a deadline at work or with conflict in a relationship, you may see changes in your results. It’s important to record information about the emotions you’re feeling and the stressful situations you’re dealing with. It’s also important to record positive emotions and situations. For example, vacations may be a positive change to your regular routine, but vacations also often cause you to eat differently and at different times. Women should note menstrual periods in their records as well; the various phases of the menstrual cycle, including the hormonal surges of adolescence and menopause, can affect blood glucose levels.

Medications

If you take blood glucose–lowering medications, it’s important for you to track the medications you take, how much, and when. This information, along with all the other factors in your records, will help fine-tune your diabetes control.

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